Dr. Alan Bauman is a hair loss restoration surgeon who discusses the evolution of hair transplant surgeries, the importance of finding a skilled surgeon, and the underlying mechanisms of hair loss, primarily caused by DHT. He emphasizes the need for a holistic approach to hair loss prevention, including lifestyle changes, medications, and regenerative treatments.
Highlights:
Dr. Justin Marchegiani: Hey guys, it's Dr. Justin Marchegiani. Welcome to the Beyond Wellness Radio podcast. Feel free and head over to justinhealth. com. We have all of our podcast transcriptions there, as well as video series on different health topics ranging from thyroid to hormones, ketogenic diets, and gluten. While you're there, you can also schedule a consult with myself.
Dr. Justin Marchegiani: J, and or our colleagues and staff to help dive into any pressing health issues you really want to get to the root cause on. Again, if you enjoy the podcast, feel free and share the information with friends or family. Hey guys, Dr. Justin Marchegiani here. Welcome back to the podcast. We are going to have an awesome show today.
Dr. Justin Marchegiani: We have Dr. Alan Bauman here at Baumanmedical. com. We'll put his links and everything below. Dr. Alan is a prolific hair loss, hair restoration surgeon. So we're going to talk about surgery. We're going to talk about medications. We're going to talk about everything hair loss, restoration, how to get to the root cause and anything natural, what's cutting edge and coming down the pipe to improve your head of hair.
Dr. Justin Marchegiani: Take care. Dr. Alan, welcome to the show. How you doing?
Dr. Alan Bauman: Hey, I'm doing great, Dr. J. Great to be with you today.
Dr. Justin Marchegiani: Yeah, same here. So tell us a little bit about yourself. We were talking before show, you're at the show and you went to medical school and how did you get into the hair loss field? Because as you said, there wasn't a direct residency path for it.
Dr. Justin Marchegiani: How did you get into this niche?
Dr. Alan Bauman: Yeah, most people are confused because hair transplant is what we call an orphan specialty. There's no direct pathway. And certainly even when I went to medical school and started my surgical training, I didn't think I was going to become a hair transplant surgeon.
Dr. Alan Bauman: Originally, I was mentored by a plastic surgeon. He was a close friend of the family, took me under his wing when I was really, before I could drive a car actually, telling me about his procedures and treatments. And I had the opportunity to watch him in the OR. Perform procedures, you know, with the artistry and skill, and then also to see his followups in his office and to see how those patients lives are changed.
Dr. Alan Bauman: And so I recovered pretty excited about plastic surgery and cosmetic procedures and treatments in general, and followed a surgical path. And, but it really wasn't until I was deep in my surgical residency that I find out about hair transplants. And I had met a patient who had had a hair transplant.
Dr. Alan Bauman: He was having some other procedure. That's why he was crossing paths with me. And he had told me that he had had a hair transplant. I'm looking at this guy thinking like, where are the plugs? So I, you know, I was like everybody else. I thought hair transplants were pluggy and probably painful. And like, you know, why do that or perform that?
Dr. Alan Bauman: But he told me about his procedure and I was astonished to see, I was amazed that it was so natural looking. It looked amazing. It looked a hundred percent normal. And we had this long conversation, well, you know, maybe less than a half an hour about his process, what he went through, how he found the surgeon.
Dr. Alan Bauman: And remember, this is back in the 1990s and I was so intrigued. I just started to look into it. Now I didn't know that that's what I wanted to do, but I figured maybe over a course of time, you know, obviously I started with some journal articles and textbooks and I went and you know, attended some conferences.
Dr. Alan Bauman: And the more that I learned about hair transplantation and the techniques that were used on him specifically single follicle implantation in an artistic way to give him a permanent and natural living and growing hairline you know, the more I got excited about it. Certainly a lot of my friends and family thought I was crazy when I decided to go more deeply into hair transplant procedures and eventually decided to specialize in hair transplant surgery way back in the mid 1990s.
Dr. Alan Bauman: But you know, it's been an amazing path. What I remember most about that conversation with that patient was not just about how great the hairline looked and kind of struck me by surprise. But also his experience after the transplant when it was growing in how it really changed his life both personally and professionally And since that comported with you know, my goal as a as a cosmetic treatment procedure provider, That's really what I remember today and and you know And I have the this blessed opportunity to have done over 12 000 hair transplant procedures to change those people's lives and to treat over 30 000 patients with hair loss and so You It's been a really fun journey over 25 years here in Boca Raton, Florida in my practice Bauman Medical.
Dr. Alan Bauman: And you know, we have fun every single day seeing those patients results and performing those procedures. It's really been an exciting ride. So I feel very, very blessed.
Dr. Justin Marchegiani: Dr. Justin Marchegiani That's cool. Let's talk about the evolution of hair loss in regards to the restoration surgeries. I remember in the 90s and I was younger, I remember the hair loss for men or the there was another big one out there and a lot of the surgeries were kind of these FUT where they do the follicle unit.
Dr. Justin Marchegiani: kind of transplants, like the big strip from the back of the head, you see the big smiley face scar and then enter the 2000s, the late 2000s, you started seeing FUE, follicle unit extraction and they started bringing on some of the machines to evenly pull out those follicles to make sure your donor sites didn't look uneven.
Dr. Justin Marchegiani: Can you just talk about kind of when you came in 25 years ago, how is that it evolved and where are we at today? Because I feel like every five years is a giant leap in the hair transplant surgery world.
Dr. Alan Bauman: Yeah. Well. Dr. Jay, that was a really good summary of the history of hair transplants from plug harvesting way back in the sixties to the, about the eighties and nineties.
Dr. Alan Bauman: And then the strip harvesting, we were all trained on that. The linear excision, which left the long telltale scar stitches or staples were used kind of a painful process. And then it was exciting for me to be a part of really the group of pioneers who are moving forward with follicular unit extraction.
Dr. Alan Bauman: FUE was something that. It was basically brand new in the early 2000s. And there was only a handful of surgeons, maybe six or eight of us kind of trying it, and I would literally try it on each patient that was having a strip procedure. I would try to get the breaths minimally invasively. That means without a scalpel, without stitches, using a tiny, small, round instrument to pluck the follicles.
Dr. Alan Bauman: Cause I, I knew from general surgery, having done that work, that minimally invasive procedures always were more comfortable, were, were more effective. going to have a quicker and more comfortable recovery. And if we could leave someone without that linear scar, I just figured they'd have so many more options in terms of hairstyling.
Dr. Alan Bauman: And so. It's exciting to see that. Obviously we were one of the first to get robotic extraction devices. And that was pretty exciting back in you know, 2016 or so, but today we use manual mechanical tools that actually allow us to take the follicles in some cases without having to trim any hair whatsoever.
Dr. Alan Bauman: And so over the years, you know, you've seen this change. Numbers of graphs and quality of graphs and the consistency of the results has really skyrocketed, not just here in the United States, but also across the world. So it's been pretty exciting to be on the forefront of that technology. You know, way back when, when I did my dad's procedure his first procedures were done with a linear harvest, but his later ones were done with FUE.
Dr. Alan Bauman: And of course, that's primarily what we do today, mostly what we
Dr. Justin Marchegiani: do. Dr. Justin Marchegiani Now, how many, how many donors, how many hair follicles are you recommending on average per transplant surgery? I go online, I watch lots of different surgery recommendations, I see the fails, right? The big fails I see people doing too many at once, or they'll bring the hairline, they'll bring it to juvenile, they'll bring it down too low, and then you're chasing that back up, and then you're having to use all these extra donor sites to fill that in.
Dr. Justin Marchegiani: What are some of the big mistakes when people go into a surgery? Is there a certain amount of follicle donors you recommend per surgery, keeping it between three to five thousand? Do you try to just keep the hairline as natural as possible? Do you focus on the receding area or the crown first? How do you customize that?
Dr. Alan Bauman: Yeah. Well, certainly every single patient that I see is different and receives a different hairline. So if you're out there like choosing a hair surgeon, right, what you're bringing up are a combination of what I would consider hard skills and soft skills. And so all of those little details that you just mentioned, the numbers of graphs that are needed, how many procedures should be done, where's the location of the hairline, what's the angle, the orientation of position of the hairline.
Dr. Alan Bauman: Is the hair that they transplant going to grow? Yeah. So you want to choose a surgeon that has this experience that can demonstrate to you that his process works actually grows the hair robustly, right? Keeps you safe, right? Doesn't put your life or your health in jeopardy, but also has those soft skills of artistry which unfortunately, as you saw out there on the internet some of these medical tourism locations out there, they're just crazy.
Dr. Alan Bauman: They're literally creating just a straight line and look, everybody kind of knows medical tourism is risky and you only have to Google Turkey teeth to find out what's going on there. That is a thing. I'm putting patients lives in jeopardy and also, you know, screwing up their teeth is a, is a very big deal.
Dr. Alan Bauman: Just like, you know, you don't want that to happen to your hair. And my dad's a dentist, so I think the teeth are kind of important as well. But you know, so, so finding that surgeon who has those hard and soft skills so that they can design an appropriate treatment plan for you. And execute it properly and you end up with something that flaunts the natural beauty and symmetry of your face It doesn't overstep the bounds of naturalness and that has the architecture of a natural hairline And as we said like not something that's straight across or too juvenile something that has a little bit of a recession on the sides Perhaps you know something that's soft and wavy.
Dr. Alan Bauman: You know, that really is what's going to be effective. And then the other piece of the puzzle is the long term or holistic approach. If you will, how do we keep the other hair that's not been transplanted hanging around? How do we keep that hair protected? Cause transplanted hair is permanent. Your other hair is not.
Dr. Alan Bauman: And so you want to have a robust treatment plan that not only transplants enough hair into the body. Into the area of thinning or baldness, but also protects the other hair. And so that's a key component. Now, whether those are lifestyle changes or medications or other modalities, like good nutrition and sleep to medications or lasers or regenerative treatments, I mean, that's really the key to this whole thing is putting all of that together you know, in the clinic with a surgeon who has your best interests and safety in mind.
Dr. Justin Marchegiani: So is there a certain amount of hair transplants that you're trying to shoot for per surgery? Trying to keep it three to five thousand, keep it as natural as possible and layer it over maybe every five or ten years you come back in. Is there a certain threshold you like to be in on average to keep it looking more natural?
Dr. Alan Bauman: Well, sometimes we do cases that are Only a thousand grafts. You know, some people just need to densify the hairline, for example, or fill in a little ball patch, right? A little thin zone. And
Dr. Justin Marchegiani: you can do that without having to shave the head fully now, you said, right? You can just kind
Dr. Alan Bauman: of come in
Dr. Justin Marchegiani: there and spot?
Dr. Alan Bauman: Correct. Correct. Again, that's, you know, one of the things that we offer is a no shave hair transplant. So we never shave the top of the scalp. Really? It'd be very unusual to have to do that in the back of the scalp. Traditionally. Yeah, we did a wide shave to do four or 5000 grafts at a time. But if we don't want to change the hairstyle or we can't like on a woman, for example, we might shave a little tiny zone or shave nothing at all now and still get the follicles that we need.
Dr. Alan Bauman: So can we get to 5000 grafts on every patient? Well, no, not necessarily. Do we need to? No, not necessarily. Sometimes the procedures are best done in small. Steps over time, depending on what the patient wants to try to accomplish and the degree of their hair loss. Like my dad, for example, he was totally bald from front all the way to the crown area, and he needed well over 8, 000 grafts to complete the work.
Dr. Alan Bauman: And luckily he had enough hair around the sides and the back to do that. We did it over several sessions. Someone like Dave Astor, who we talked about who's a very public patient of mine we talked about him before we got on the air. You know, he had a single procedure to restore the hairline as well as a bald crown.
Dr. Alan Bauman: So you know, nearly, nearly 5, 000 grafts on Dave. So everybody's a little bit different. Some people need more, some people need less. If you're doing an eyebrow, it might grafts on each side.
Dr. Justin Marchegiani: Very cool. Now, let's talk about the underlying mechanism of hair loss, right? I mean, the old adage is we have testosterone, metabolite, DHT, the heterotestosterone's coming in, that's causing miniaturizations, causing the follicle to get thinner and thinner and thinner, and then eventually fall out.
Dr. Justin Marchegiani: Is that the major mechanism that we're dealing with, or is there anything else that's coming? Because obviously we know low thyroid maybe cortisol imbalances, maybe poor diet or not good having good protein absorption. What do you think the top three or so mechanisms outside of DHT you think are impacting hair?
Dr. Alan Bauman: Yeah. So what, you know, what you're saying is obviously very, very true. We're seeing primarily in the clinic we treat Androgenetic alopecia. So that's a diagnosis, right? Male or female pattern hair loss. The sensitivity to DHT is what you inherit in those cases. What we found is that there's a lot of things that could dysregulate the hair follicle on top of having this tendency towards male pattern baldness.
Dr. Alan Bauman: And it's been revealed. Unfortunately through COVID and vaccination that you could dysregulate the hair follicles in that way, shape, or form. Poor sleep and nutrition for sure. Anything that dysregulates your health and wellness can affect your hair. Your hair follicles are the most highly metabolic cell population in your body.
Dr. Alan Bauman: They have the highest mitotic rate. So they're very, very sensitive to changes in nutrition and fuel. They're very sensitive to changes in your overall wellness. Sleep wake cycles can dysregulate them as well. Inflammation in the body, inflammation at the scalp can disrupt the hair follicle cycling and and a number of other things.
Dr. Alan Bauman: So we, we definitely want to take a good holistic approach to what's going on with the body. Medications like blood pressure, medications mood modulators. There's so many medications that could dysregulate your hair. We want to keep a close eye on that as well. You asked specifically about testosterone and DHT.
Dr. Alan Bauman: We know that's the primary trigger. So for male pattern hair loss, we're always talking about, you know, should we consider an approach to block or inhibit the formation of DHT in the body? And that could be done finasteride or Dutasteride. Those are pharmaceutical treatments. Of course, salt palmetto does address it in that way organically or nutritionally as well.
Dr. Alan Bauman: And there are other things that maybe will help. block androgen receptors topically on the scalp as well. So that's really you know, to create a treatment plan, we want to take a look at the whole person and the whole environment, I guess, what they're dealing with, and then put together a plan of action to help protect the hair follicles.
Dr. Alan Bauman: Maybe with the anti androgen perhaps, but also what can we do to stimulate the follicles and there's a bunch of pharmaceuticals and other ways you know, in regenerative medicine to do that as well. Dr. Justin
Dr. Justin Marchegiani: Marchegiani Okay, let's talk about DHT a little bit. So, you know, you have finasteride out there which is oral and it's also moving more to topical.
Dr. Justin Marchegiani: People are talking about, you know, wanting to get the maximal reduction of DHT in the scalp without impacting the serum. One of the first things that I learned about is I thought, hey, if we tested someone's DHT in the serum, Right? And it was okay. That means the scalp DHT is okay, but it seems like it's not the case.
Dr. Justin Marchegiani: Do you have a way of testing someone's scalp DHT over just the serum and the blood? DrMR
Dr. Alan Bauman: So, well, there have been research studies that can test scalp DHT, but remember that what you've inherited, if you have male pattern hair loss, Yeah, is the sensitivity to DHT. So you maybe have a different level of sensitivity than your brother or sibling or another relative perhaps.
Dr. Alan Bauman: And so if you have a high degree of sensitivity, even a minuscule amount of DHT, Could potentially miniaturize the follicles. So it's not necessarily the absolute value of DHT that's either in the serum or in the, in the skin. But it's your sensitivity to it. And so there's some genetic testing that can elucidate that.
Dr. Alan Bauman: We can also look at metabolic pathways genetically to see if you're converting more testosterone to DHT through either the type one or type two, Five alpha reductase pathways. And so that can help us decide which medication you'd maybe be better off taking in order to, to inhibit the DHT. If you're sensitive to DHT inhibitors, that's about 2 percent of patients are.
Dr. Alan Bauman: What that means is that obviously you can treat yourself with finasteride. If you're on finasteride orally. And you may have, you have that 2 percent chance of sexual side effects, like decreased libido or mild erectile dysfunction, even though they're mild and temporary, if they occur, you can stop the medication and it comes out of your system.
Dr. Alan Bauman: If that's a no, if that's a non starter, you can't tolerate that medication, then we like to use a topical finasteride. In lieu of the oral. Dr. Justin Marchegiani
Dr. Justin Marchegiani: Now, let's talk about the dosing, because the typical dosing out of the gate was one milligram, I think by Merck. I think when they got the FDA approval in 98, they started out with the one milligram.
Dr. Justin Marchegiani: But I never really saw them go into lower, lower testing. I've seen a couple of studies. I think it was the, the mozzarella study. There's been a couple since then, where they would go down to 0. 1 milligrams of finasteride topical, and they would still see almost 80 percent of the same reduction of DHT as that Dr.
Dr. Justin Marchegiani: Justin Marchegiani oral one milligram without having the spilling over to the serum. What's your thoughts on micro dosing or going lower? Maybe every other day or so. Cause I know that the binding effects about five days. So it doesn't quite make sense to go maybe every day. And some people, what's your thoughts on that?
Dr. Alan Bauman: Well, here's the thing. We know the dosing studies that were done by Merck, which we're going to try to figure out what's the correct dose that has the least amount of side effects that has the best effect on the hair. Right. And so it is true that in those dosing studies. Because remember, they also had the studies done for large doses, just for prostate, right?
Dr. Alan Bauman: So, so proscar was a five, right? So you are absolutely correct that that a one 10th of a milligram on a daily dose, you could get a systemic reduction in DHT. But the problem was, is that, that, that the systemic reduction of DHT with that dose did not significantly improve hair growth very well. And so again, that's the, that's the problem or red herring, if you will, by looking at your DHT levels, thinking that that's the solution, you know, just by knocking your DHT levels down, doesn't necessarily mean that you're going to get good hair growth, or maybe you need to knock it down even further potentially.
Dr. Alan Bauman: So you're absolutely right. Dosing strategy wise. I always like to say, what's what patients will do. Best is what's going to work best. And so taking a medication daily is probably the easiest way to make sure someone is adherent to a regimen. You know, I know personally, I take a lot of supplements and if I had to take something every other day, it becomes very, very difficult.
Dr. Alan Bauman: I don't know, maybe it's just because we have a five day work week. I'm not sure if that's the problem, but taking something every other day can sometimes be very difficult. If we do it once a week, maybe that's easier, you know, Sunday night, I'm going to take this. You know, so I will always suggest to patients that we start off with a daily dose and see how that works.
Dr. Alan Bauman: Now, how do we know if it's working instead of measuring, you know, serum DHT every week or whatever, let's look at the end organ. And so what do I mean by that? In the office, we have AI powered microscopes. We also have hair check trichometers. Those are two different, very sensitive measurements to not only your hair loss condition, like where you are currently in a baseline, but also how you're changing over time in response to any therapy.
Dr. Alan Bauman: I don't care if you're standing on your head with a yoga pose every night. I want to know how that number changed after. A certain period of time. And usually it's about 90 days. Sometimes you can measure some changes in six weeks, but usually 12 weeks or even 90 days, you know, 90 days, usually the right answer in terms of when you should come in for those repeat measurements.
Dr. Alan Bauman: And so if you've made a change to your regimen, the first place you're going to see a change is not necessarily in the mirror, And hardly ever in the mirror burst off. It's gonna be in that measurement 90 days later. That's how you know what's working and where.
Dr. Justin Marchegiani: Interesting. Now, what's your take on post finasteride syndrome?
Dr. Justin Marchegiani: I've gone through some of the studies and it seems like the overall side effect profile on finasteride orally is about 2%. I've also looked at some of the nocebo studies where they went through and they told people about the side effects, these could be the potential side effects and then the side effects reported in that, in those studies went up 6 to 8 fold.
Dr. Justin Marchegiani: So there's definitely a psychosomatic impact on that. What's your take on post fenasteride syndrome and then people that are sensitive in that 2%, do you find a topical? Finasteride, maybe in a, in a carrier that's less likely to go systemic is a better option if they want an additional pharmaceutical option to keep the DHC down?
Dr. Alan Bauman: The interesting thing about post finasteride syndrome is that when you ask a huge group of hair transplant surgeons who basically prescribe finasteride to the largest number of patients worldwide you know, do you see, do Persistent side effects even after stopping the medication. The answer is almost next to none in those large cohorts of physicians.
Dr. Alan Bauman: And so and remember, these are like anonymous surveys that you do while you're at the conference. And so it's interesting, like how rare it actually is in a clinical setting. Personally, I have not treated anyone with post finasteride syndrome. I've never seen an irreversible or persistent side effect once a patient stops finasteride.
Dr. Alan Bauman: Now, as you know, what we're talking about here is a decrease of libido or potentially erectile dysfunction, which actually has a Yeah, but those those two are the main side effects that we see in finasteride patients about 2 percent of the time, but most people don't realize that more people left the clinical trial in finasteride in the placebo group due to due to side effects than people in the actual drug group.
Dr. Alan Bauman: And so that that corroborates your nocebo effect which we, we know is a well known factor. In these kinds of conditions, and then someone brought to my attention just recently that those who published some of the studies originally on post finasteride syndrome were actually financially compensated by the companies who were looking to bring class action lawsuits against the big pharma companies like Merck.
Dr. Alan Bauman: Dr. Justin Marchegiani
Dr. Justin Marchegiani: Yeah, absolutely. And I like to look at the mechanism. If someone were to have that, I see people that are on a low dose finasteride actually have improved libido. And it makes sense because if you have testosterone and it's going downstream to DHT and you plug that pathway up, you have the study show a 15 to 20 percent increase.
Dr. Justin Marchegiani: So I like to look at it and say, well, why, why would someone have a side effect? Maybe we're plugging up the testosterone and maybe it's aromatizing downstream to estrogen and maybe we're getting that bump in estrogen, right? So I think it's good though. So, if you're doing a medication, maybe look at your labs.
Dr. Justin Marchegiani: If you're one of these guys on the high end of testosterone, maybe you look at adding in some estrogen support on the detoxification side. Maybe some DIM, maybe some NAC, maybe some support to help that get metabolized fully versus aromatized. What are your thoughts? Dr. Justin Marchegiani
Dr. Alan Bauman: No. I mean, that, that's, that's super intuitive and and I think spot on.
Dr. Alan Bauman: You know, Dr. Justin Marchegiani In the general public, we know that the average patient with hair loss, you know, they might be in their 30s to 40s. That is a common age for decreased libido and erectile dysfunction. And actually it's more common than what we see in those clinical trials on the finasteride.
Dr. Alan Bauman: So then it begs the question, actually, is finasteride maybe even protective of sexual side effects since it only happens in 2 percent of patients where it's much more common in the general public in those age categories. So I think that out that out there, you know, another explanation could be that some people have a dht dependent libido I mean, it's certainly possible.
Dr. Alan Bauman: I don't know what your genetic makeup is and we don't know your sensitivity in different organs, right? We we can maybe consider What's the sensitivity to dht in the hair follicle? But maybe there's other areas of dht sensitivity that we haven't yet elucidated you know in the in the literature and in clinics and and so forth But what I notice is that If patients have a reported side effect from starting finasteride and I'm talking about like smelling the pill because you know, you have those stories too.
Dr. Alan Bauman: Oh, I took the pills home and I smelled them and now I have erectile dysfunction. You know, I have a hard time believing that. But if you've been taking the medication for a couple of weeks and you just feel off, you know, you feel like, you know, your libido is not the same. You know, something's, something's going wrong below the belt there.
Dr. Alan Bauman: Stop the medication. It's going to come out of your system in a week. That's what the pharmacology and the pharmacokinetics tell us. And so you're going to be back to normal in a week. And then we have to decide, do we want to use an antigen, an anti androgen or an antigen blocker or a DHT blocking agent?
Dr. Alan Bauman: Again, do we go with a micro dose if you're willing to try? Or do we go to every other day dosing? Maybe you'd be sensitive, not sensitive to a smaller dose. Or do we apply the finasteride topically, where there's minuscule absorption into the system and a much lower chance of sexual side effects.
Dr. Alan Bauman: In fact, I've never seen or heard a report sexual side effects from topically applied finasteride. Dr. Justin Marchegiani
Dr. Justin Marchegiani: And that makes sense. I like the topical aspect. It's interesting. They went more of that direction with minoxidil, but then kind of switched on the other side. I know Merck did come up with a patent, I think around 2004.
Dr. Justin Marchegiani: a topical finasteride, but they never did anything with it, which is kind of odd, which is interesting. And so, do you recommend, like, you know, someone's 30, 40, maybe their hair started, do you recommend a lower dose preventative finasteride or something topical for DHT, just for guys on the more preventative side?
Dr. Justin Marchegiani: What's your take on that?
Dr. Alan Bauman: Well, again, the most important thing, if you think that your hair is thinning is to get an evaluation by a full time board certified hair restoration physician who can measure your hair and give you a baseline, you know, in the world of health and wellness today, it's all about metrics.
Dr. Alan Bauman: And so if you think that you're going to be able to track your progress by looking in the mirror please be aware that you could change your density 50 percent one way or the other, and it still looks about the same. So you could lose. 50 percent of your hair density and it will look the same to the naked eye.
Dr. Alan Bauman: And that's the miracle of hair transplants, but also the detriment of hair loss, which that it can sneak up on you. So the measurements are critical. Now, if you've had the measurement, what could we do? We could try the standard dosing. We can try low dose. We can try infrequent dose. We can try changing the timing of the dose.
Dr. Alan Bauman: There's a zillion different ways through compounding pharmacy that we use today. to really you know, alter the dosing strategy of whether it's finasteride or aminoxidil to make sure that's tailored specifically to the patient. And whether it's finasteride or dutasteride, you know, sometimes we need to do genetic testing to see what you're more likely to be responsive to.
Dr. Justin Marchegiani: So with dutasteride, that's going to be blocking the type one and type 2 enzyme, right? So, you have your, your alpha reductase enzyme or you have type 1, type 2. Finasteride mainly does type 2. Dutasteride's gonna do type 1 and 2, and it does about 90%, where Finasteride does about 70. I know Dutasteride, they say that it also can maybe block some of the neurosteroids in the brain, so that's kinda like your big gun, right?
Dr. Alan Bauman: Dr. J, you are the most knowledgeable podcast host on hair loss and I bet I've been on a lot of podcasts. So, so, you know, congrats to you, but yeah, you're following literature correctly. You know, if you are, if you have a propensity for high type one activity, that would indicate that we might need to consider the Dutasteride because that becomes a bigger pathway to the DHT.
Dr. Alan Bauman: So yeah. you know, those would be the times that I would consider for our patients, maybe switching from finasteride to dutasteride. And we also have topical dutasteride as well as mesotherapy dutasteride now.
Dr. Justin Marchegiani: Let's talk about that. I want to hear more about the mesotherapy. So with the dutasteride, that has a very slow breakdown.
Dr. Justin Marchegiani: So you can do that. What? So, what's the frequency, which, what, do you recommend that for people kind of starting out? How do you decide a topical versus going mesotherapy? Dr. Justin
Dr. Alan Bauman: Marchegiani Yeah. So, starting out is the operative word there. So when you're starting out, we always start with the basic things.
Dr. Alan Bauman: Unfortunately, in the world of hair loss, it seems like whatever press release just came out. That's what everybody wants to be on first. And that, that's what we do. I would say I'm a little bit more of a conservative guy on that. I do love new technology. Don't get me wrong. I love being progressive and seeing what works for patients.
Dr. Alan Bauman: I mean, whether it's growth factors or peptides, you name it, but we always start with the tried and true because we have the largest amount of data. In the practice, we have the largest amount of experience. With those treatments and so I will always talk to the patients about the basics first, but you're absolutely right.
Dr. Alan Bauman: You know, using these other modalities, we can certainly investigate and look at other things that you know, to add to the regimen, whether it be, you know mesotherapy, do test, right? Let's look at what the research shows. Let's look at the data. Let's look at the published research. And so our protocol is that you can do this.
Dr. Alan Bauman: In the beginning, we started up once a month and then we go to every three months with the mesotherapy.
Dr. Justin Marchegiani: Okay. And what about someone that's microneedling once a week? Could they microneedle and then that night add in a topical finasteride and with that kind of, you know, an at home kind of therapy where you combining the microneedling a little bit with that?
Dr. Alan Bauman: Yeah. So what I've learned first of all, I'm a huge fan of microneedling. I believe that the microtrauma is important not only when we apply our PRP injected into the scalp painlessly, we do microneedling along with that. We do microneedling of growth factors and peptides in the practice. We do microneedling of exosomes, a lot of different microneedling.
Dr. Alan Bauman: When people call the office or talk to me in consultation and say, Hey, I've been micro needling at home. There's a wide variety of different types of things that they keep talking about. You could be using a little stamp that goes, you know, 0. 25 millimeters, which is basically just something that's going to maybe enhance the penetration or even just the vibration of tapping it 0.
Dr. Alan Bauman: 25 thing on your scalp has some trigger of hair growth. Cause we know that hair follicles recognize vibration. You could be using a derma roller and we have derma roller kits in the practice called the preppy suite. That can be used in conjunction with topicals or honest as a standalone. Those are gold plated rollers that are specifically designed for the scalp to minimize the risks of doing micro needling at home.
Dr. Alan Bauman: And then I would say more common today, people are buying the mechanical pens. That's where the danger I think really starts. And so mechanical pens can be, first of all, very messy. If you're creating a lot of bleeding you could create a lot of excessive trauma, which could actually hurt your hair growth.
Dr. Alan Bauman: So I do not recommend that. And so imagine for a moment, buying a microneedling pen off of Amazon for a hundred dollars and hitting that to your scalp versus a professional microneedling tool that we use in the office, which is about a 10, 000 item. I mean there's a huge difference between the way that those tools are created manufactured, engineered, even sterilized.
Dr. Alan Bauman: Someone I spoke to just this week says they've been using the same microneedling tip on their mechanical pen at home for the past six months.
Dr. Justin Marchegiani: Oh wow.
Dr. Alan Bauman: All they do is they're dipping it in alcohol and okay. I said listen if you think that that device I mean we we use it's a one time use on those cartridges You toss them after you use it the first time if they're even packaged sterile from amazon Who doesn't even know is where you're getting it from, you know, ebay or china or something?
Dr. Alan Bauman: In the office each one is sterile Packaged hermetically sealed front off from the mechanical portion of the microneedling tool and is disposed after every procedure. So my gosh, there's so much risk involved with doing that at home. I would say just be careful out there and use your, you know. Use your head.
Dr. Alan Bauman: No pun intended. Yeah. Use what's inside, you know, to think about what you're doing could be really hurting your scalp and, and doing the opposite of what you're trying to accomplish. So, so speak with a physician who is an expert in microneedling. That's what we do before you start doing this DIY stuff, YouTube style at your home.
Dr. Alan Bauman: I mean, my gosh.
Dr. Justin Marchegiani: And yeah, definitely. Don't you want to make, make sure you change those heads out for sure. Is there a certain depth that you like that one 1. 5 millimeter? Is that kind of a good place? I think the literature is showing some, some good benefits to that level. Is that what you use in the office or do you go deeper?
Dr. Alan Bauman: In the office, we typically will use a 1. 5, but it's, it's adjustable. It's literally micro adjustable. We can adjust that, that tool. To create just the correct level of erythema and punctate bleeding. That's what we want to see when we're applying microneedling in the office. And we're doing that with local anesthetic.
Dr. Alan Bauman: And I'm not talking about some anesthetic cream that takes three hours or never to soak in. I'm talking about an anesthetic ring block that the same as what we use for surgery, which is comfortable and long lasting so that you're not like undergoing a torture chamber. So the point is, is that, you know, these are, there's a lot of nuance when people throw out the word, Oh, I did PRP or I did microneedling and it didn't do this or did that.
Dr. Alan Bauman: You have to kind of dial down until exactly and dig deep into what exactly they mean and, and what kind of results they were expecting from that treatment.
Dr. Justin Marchegiani: Yeah. I want to dive into some of the other therapies that you were talking about earlier with the PO at PRP and the exothelm. But I've also seen people that have, said, okay, I'm going to go get hair surgery, hair transplant surgery.
Dr. Justin Marchegiani: And then I've seen people say, you know, wait a year, get, get some of the, the growth factors on board, get some of the DHT blocking on board. And I've seen five, six, seven, 8, 000 hair follicles come back and now their surgery neck needs to be smaller. They need to take less from their donor sites. Do you recommend getting the underlying mechanism of the hair loss stabilized before you go under?
Dr. Justin Marchegiani: So then you need less hair loss. kind of donor follicles to be used. What's your take on that?
Dr. Alan Bauman: Oh, absolutely. I mean, you know, it's not necessarily mandatory. Like I've heard from some doctors that you have to be on finasteride for, you know, this period of time. I mean, of course, we're going to tailor the treatment to each and every patient.
Dr. Alan Bauman: So there's no hard rule. You can bet that the bulk of my conversation in consultation with patients every single day is not just about the transplant that they need, but it's about those medical therapies or alternative other therapies, adjunctive treatments to help protect the hair they have. I mean, even if they're contemplating a procedure, they may be, maybe they're going to get on the schedule in a couple of months, you know, Before that we're going to get them started on medical treatments and make sure that they're stabilizing or stabilize or even having some regrow That's great on the game day.
Dr. Alan Bauman: Do we reduce the number of grafts phenomenal? That's like a good thing That's not a bad thing.
Dr. Justin Marchegiani: Dr. Justin Marchegiani Very good. And talk about the PRP, I've seen, you know, some of the studies on it, it's like, eh, maybe microneedling and minoxidil or some of these topical things is just as good. Are you seeing, in your clinic, better results with the PRP than like, let's say, mesotherapy?
Dr. Alan Bauman: PRP is like pizza. Everybody thinks they're making the same thing and every time it's different, right? Let's hear about that. There's, you know Platelet rich plasma is something I have a lot of experience with. I was super excited to have the first team of surgical technicians actually certified to produce an FDA cleared version of PRP way back in the mid 2000s.
Dr. Alan Bauman: And that was a process called autologel, which was really the first FDA recognized PRP process for wound healing. So we have a lot of experience, over 12, 000, nearly 13, 000 PRP treatments in the practice. And we've tried every kit possible under the sun. And so it's been a very well wrought procedure.
Dr. Alan Bauman: And I think what people misunderstand about PRP is a few Key items. First of all, PRP stands for platelet rich plasma. That means platelet rich, how rich, meaning how concentrated is your platelet rich plasma. And most providers have no clue or they're trusting the word of their local salesperson as to how many platelets are actually in the the platelet rich plasmid that they've been taught how to produce.
Dr. Alan Bauman: So I got tired of all of that back over, you know, maybe 10 or 15 years ago. And I bought a device called a coulter counter. That's a hematology measuring device. It's about the size of a dorm fridge and you could put in just several droplets of PRP and it will spit out, print out exactly the components of what's in there.
Dr. Alan Bauman: How many red blood cells, how many white blood cells with the breakdown and also how many platelets. And so it gives us a platelet concentration. And so what do I do with that information from each patient i'm going to take the from the blood sample We're going to test their platelet concentration or what they walked in with in their blood and then we're going to prepare our prp Appropriately to get to the accurate and specific dose of platelets that we know in our hands at Bauman Medical works best for hair regrowth.
Dr. Alan Bauman: And so that secret dose I'm going to tell you right now is 10 to 14 billion platelets. And so in order to do that, we need to take 60 to 70 CCs of blood. We need to spin it in a very appropriate way, a dual spin process so that we can get rid of the red blood cells and concentrate the platelets and harvest them appropriately.
Dr. Alan Bauman: And I will tell my friends and colleagues out there as I do every single day, I'll be presenting also this information at a medical conferences this year in in Vegas in a couple of weeks just like I've done over many, many years. If you're using a gel separator test tube to create your PRP, I think you will be shocked and surprised that sometimes you have less platelets in there.
Dr. Alan Bauman: Then the whole blood in terms of concentration. And so you could be losing, you could be losing your platelets either below the gel separator or inside the gel. And it's been proven that the gel separator, you know, single spin PRP is certainly not going to give you a platelet concentration like what I've just described.
Dr. Alan Bauman: It's impossible. You need a dual spin process in order to make that happen.
Dr. Justin Marchegiani: So dual spin, and that's called the coulter counter.
Dr. Alan Bauman: Well, the coulter counter is a measuring tool. The dual spin is one of the techniques that we use to get to that 10 to 15 billion. Yeah. And so it's about 1. 5 million platelets per microliter.
Dr. Alan Bauman: And that means we're going to do a seven and a half CC injectable from the original, like let's call it 60 to 70 CCs. And that's what's gonna, what we found in our hands in our clinic, it's going to have the best results in terms of PRP. It's actually one treatment per year. That's all you will need.
Dr. Justin Marchegiani: Oh, very cool. I want to pivot to exosomes, but I forgot to ask one question earlier. Are you ever still doing the FUT strip procedures these days? And if, and if so, who?
Dr. Alan Bauman: So no, I don't perform any linear harvests whatsoever in the practice anymore. So we've abandoned that technique. I'm not saying I would never do it again.
Dr. Alan Bauman: I certainly know how to do it. I did thousands of those procedures. I just, you know, I don't come across any indications for that. And surgeons often say, at least I hear this from some of our consultations where patients have gone to clinics and they've been trying to be either, you know, you know, they, their consultation with another surgeon, another clinic have, have kind of encouraged them to go the route of the FUT as opposed, or the linear harvest as opposed to FUE.
Dr. Alan Bauman: And they will say, well you know, the FUE doesn't provide as good results. And what I say is that what they missed from that sentence was in their hands. And so for those of us who have specialized in in follicular unit extraction over many, many years, a decade and a half and perform, you know, tens of millions, if not a, you know, a hundred million extractions or whatever the number is we've got it down.
Dr. Alan Bauman: And so hair growth rates are very high quality is excellent hair density, robust. And so, you know, if, if you go to a surgeon, who's trying to talk you out of FUE, you may want to try to figure out why that might be. Maybe they just don't have experience in doing it.
Dr. Justin Marchegiani: Very good. And what kind of technology is now enhanced, came in the last couple of years.
Dr. Justin Marchegiani: I know people are using more machines for the extraction to make sure it's fully even. What's, what's coming down the pipe now? And, and where do you see us going in the next few years? Can we, can we, can we 3D print and just take a one follicle and make it into 10? What's coming down the pipe?
Dr. Alan Bauman: Yeah, so the holy grail of hair restoration is to be able to duplicate right hair follicles and we unfortunately don't have that ability yet But let me tell you there's a lot of smart people and there's a lot of big money behind it you know working on that those research projects to try to do it and there are people who have come close But that have not succeeded yet But in order to be prepared for that I think it's really, really important to bank your hair follicle stem cells.
Dr. Alan Bauman: And this is something that I've done personally for my own hair follicles and not just for my hair, which I, you know, I love my hair. I want to keep my hair, but also I feel banking the mesenchymal stem cells from the hair follicle is an important like hedge or insurance policy that will enable us in the future to use regenerative medicine.
Dr. Alan Bauman: To rejuvenate hopefully aging tissues or replace organs or stimulate repair in the future. And so there's certainly a lot of evidence that using those younger cells that you wish you had banked earlier as I think is the best potential option. So I now know frozen in time, my STEM cells from 2023.
Dr. Alan Bauman: Are hitting the cryo fridge and that's where they're going to be until eternity, I guess, or until I don't need them anymore.
Dr. Justin Marchegiani: But that's cool. Do you predict like in the next 10 years, we're going to just be able to take a few hair follicles and grow thousands from it? Is that kind of where you see it going?
Dr. Alan Bauman: Well, you know, I'm a bit of a Star Trek guy and I always like to try to look a little farther around the corner. And I think that we will have some kind of, whether it's the 3d printed hair follicles available or someone's going to figure this out. I mean, there's a lot of smart people working on it.
Dr. Alan Bauman: And I just think that there's a huge demand for hair. Obviously hair is something that makes you look good and feel good. And so, you know, there's certainly a what I would say a big market if you will. And you know, I would encourage investors to get involved in the, in the hair growth field. You know, because there's a lot of potential there in the biotech world.
Dr. Alan Bauman: And many of my friends are working on that. You know, we have friends who are at Stemson, for example, in San Diego, California, and they were the ones or Lexi Tursky, you know, is a great brilliant scientist who was able to. Create a dermal papilla cell from induced pluripotential stem cells to create these hair follicles in the back of a nude mouse.
Dr. Alan Bauman: And I know that they're hard at work trying to make that happen in other larger mammals, I guess is the point. And so, you know, they're hard at work on that. And so stay tuned. I haven't heard much about it as of yet. You know, in a couple of, you know, a couple of months, but they always seem to have a new breakthrough.
Dr. Alan Bauman: So stay tuned on that.
Dr. Justin Marchegiani: Very cool. By the way, is this real? If someone has similar hair to you, can they donate hair for you? And then you can put it into that person's scalp? Is that possible or not?
Dr. Alan Bauman: Yeah. Unfortunately, you're going to reject that. That's alternative tissue. The only person to person transplants that have worked is in fact, I just saw the surgeon who did it recently at a conference in India in Delhi just a few weeks ago.
Dr. Alan Bauman: It was a gentleman who had received a kidney transplant. And this was a number of years ago. He received the kidney transplant, I don't know, 15 or 20 years ago. And he has since received also the hair transplant from that same person, and it was successful. Wow. And probably the reason it was successful is that he was a good tissue match to begin with.
Dr. Alan Bauman: And also the fact that he's on hardcore immunosuppressive medications. All right, so that's the important take home message. So do you want to be risking? You know all of the potential side effects of hardcore immunosuppressive medications just to grow your hair back I don't know But you need to find a good tissue match in order to do it And there are some ethical implications to that process in terms of proceeding with further research so I don't to my knowledge.
Dr. Alan Bauman: I don't think it's been done here in the united states But it was an exciting and interesting, research, case study that was presented You at the International Society of Hair Restoration Surgery just a couple of weeks ago.
Dr. Justin Marchegiani: Very cool. I want to get into the, the psychology of hair loss. It's really interesting.
Dr. Justin Marchegiani: You see a lot of celebrities, especially men as they kind of age, the hair starts to go and they, you know, they, their hair starts to come back and they do stuff about it, but they very rarely, there's like not like a public campaign where guys can openly talk about it and say, Hey, this is what I'm doing.
Dr. Justin Marchegiani: It's always very closed lip. I mean, you see it with Matthew McConaughey. He's obviously had a hair transplant. If you go back to his old pictures, even Elon Musk, And people just don't talk about it. It's not out in the open where people are openly sharing and saying, these are my successes, maybe on Reddit forums.
Dr. Justin Marchegiani: Can you talk about that psychology a little bit?
Dr. Alan Bauman: Yeah. I mean, I think it's a little bit less taboo than it was. So definitely a good thing that people are talking about it. There's, you know, weekly radio shows like the bald truth where people can talk about hair loss and hair restoration treatments and procedures and surgeries and surgeons and so forth.
Dr. Alan Bauman: Certainly an interesting place, for sure to hear all about hair loss and hair transplants. I think that there's just a still, there's a little bit of taboo, you know, how do we keep it secret? Right? And so that's really, really why patients want to know, well, can I do this procedure without shaving my head?
Dr. Alan Bauman: How do we keep this 100 percent discreet? So nobody knows and when it grows in it should look 100 percent natural just turning the clock back slightly So I think it's different than, you know, some other cosmetic procedures, like perhaps for women where they're, you know, maybe getting breast augmentation as much larger than they had.
Dr. Alan Bauman: And it's not dramatically different than what they they're born with. The hair is something that you were born with. So it's okay to want it back. I think it's like, if you knocked out your front tooth, I mean, tomorrow I would be in the dental chair, you know, getting something to fix that. And so I think it's the same with hair.
Dr. Alan Bauman: I think they should talk more about it. Kudos to those people out there. Influencers or other folks like Dave Asprey who have gone public with their hair transplant procedures. There, I think there's more information out there about that now today than there was many, many years ago. I just remember a quick story.
Dr. Alan Bauman: We did a procedure. On and treatments for about five patients. And they were followed and featured on Dateline NBC back around 2004. So this was like in the early days, it was still strip harvest when we did their procedures and treatments. But it was like the first time that actually like a large national news program was invited into the OR to see the procedures and treatments that we do.
Dr. Alan Bauman: And actually it was like a challenge to see if the person with the hair transplant would grow more hair than the finasteride patient. Well, guess what? You know, it didn't take a, you know, a brilliant surgeon to be able to tell you, of course, of course you know, the, the surgery is going to do more than just the finasteride, but that was the, those are the questions that were being asked, you know, 20 years ago, does a hair transplant actually work and do these medications actually worked?
Dr. Alan Bauman: So it was kind of interesting. And then of course we did procedures on the local anchorman and he followed his procedure. And so the anchorman hair transplant was one of the most popular YouTube videos back around that same time, 2005, 2007. And then of course the explosion of everything out there on YouTube and today, Instagram, Tik TOK, you can see hair transplant influencers all over the place.
Dr. Alan Bauman: So people like Spencer Stevenson specs is very out forthcoming about his procedures that he had, he had about 13 different procedures. In fact, he's so publicly recognized that he now selects surgeons to be in his list of top surgeons in the world. And, you know, I feel very blessed to be included in that.
Dr. Alan Bauman: And that's one of the places that a lot of patients do find me when they do the search.
Dr. Justin Marchegiani: Very cool. I got two more questions. First one, let's talk about minoxidil. That's one of the major medications that first came out FDA approved. I want to say late 80s, finasteride was at 98. So minoxidil, right, started off as a blood pressure medication, vasodilator.
Dr. Justin Marchegiani: In the study, they just saw lots of hair growth as one of the side effects. So they kind of repurposed that. It started coming out as topical. Right. Works on sodium potassium pumps. I want to get your kind of take on how you think it's working. And then dermatologist just recently has seemed to be going more in the direction of taking it orally.
Dr. Justin Marchegiani: I think because the liver activates it into a into a minoxidil sulfate kind of compound. You can do similar with the microneedling as well, but then you kind of have some of the potential. Dr. Justin Marchegiani fluid around the heart, maybe some aberrant EKG. I want to get your take on minoxidil and whether you like it oral or topical.
Dr. Justin Marchegiani: Yeah. So,
Dr. Alan Bauman: You've just given a brilliant history of minoxidil. One man's side effect is another man's cure, right? And so the problem with the original Rogaine and most over the counter minoxidils, and even today's cloud pharmacies by all the ones that you can name, of course, is that very often the product, which is the minoxidil, which is a very effective hair growth treatment.
Dr. Alan Bauman: Is kind of lost in this, you know, gooey oily mixture, which has a hard time finding its way to the scalp. Now, sometimes it's user error, right? You're spraying on the foam and it's getting all in your hair like a styler and it's not getting to the skin. Minoxidil is a scalp treatment, not a hair treatment, right?
Dr. Alan Bauman: So that's part of the problem. And then a huge number of patients are actually getting an irritation or inflammation from the over the counter products, which actually inhibits not only their use of the medication, but also could even be detrimentally affecting their hair growth. If they have, for example, like topic dermatitis, so it's been no secret in the world of hair transplant surgeons that.
Dr. Alan Bauman: Low dose oral minoxidil is a very powerful weapon for hair loss. And so it really started to come to the to the eye of the American public and even around the world when the New York times did a front page cover story on it about two years ago. But, you know, we've been using it for over 10 years.
Dr. Alan Bauman: This is not something new. And so you mentioned some of the side effects. I think the most important side effects to realize with oral minoxidil is, as you said, high heart rate. It could be low blood pressure. You could have water retention, but these are so rare in the micro dosing level. And so, yes, we make patients aware of it.
Dr. Alan Bauman: And the other heart effects that you mentioned at the micro dose level those cardiovascular effects you know, are, are minuscule. And so we have a lot of patients. I take it myself. Look, I'm, I'm a five, eight, one 65. And I take 2. 75 milligrams of minoxidil a day, and I've had a great result from it.
Dr. Alan Bauman: My hair mass measurements have increased and then stabilized. And for others, it can be a miraculous regrowth if they have. Major amount of miniaturization going on.
Dr. Justin Marchegiani: Does it affect systemic body hair or does it just go right to the scalp?
Dr. Alan Bauman: So it can, when you're taking it systemically it's going all over the place.
Dr. Alan Bauman: Never have I had an email patient complain of extra body hair. You know, most people don't even. Realize it's happening. But when we do treat our female patients, sometimes that's an issue. Women can have a little bit extra facial hair growth. Sometimes it's a little extra right under the sideburns or if they're prone to a little upper lip sometimes they have it there.
Dr. Alan Bauman: It's very unusual to see it in other places, but it can happen again, dose dependent. So take the dose down. That's why you need a good quality compounder, you know, again, not a cloud pharmacy and and work with a physician who can titrate it for you. to minimize those risks and maximize your results.
Dr. Alan Bauman: The other thing I found is that minoxidil orally even works much better in conjunction with other therapies. So if you combine oral minoxidil, for example, with red light or low level laser light therapy, you're going to have a much more powerful effect. Dr. Justin Marchegiani
Dr. Justin Marchegiani: That's good. And then I know, is it, with yours, do you kind of compound the finasteride and the minoxidil together?
Dr. Justin Marchegiani: Is that still beneficial? Dr. David
Dr. Alan Bauman: So, you mean on a topical version? Dr. Justin Marchegiani
Dr. Justin Marchegiani: Yes, if you do it all at the same time, so when you
Dr. Alan Bauman: topically add it. Dr. David Yeah, so, so the original Rogaine replacement, if you will, is called 82M, and that was a formula by Hair Science, and that's a prescription formula.
Dr. Alan Bauman: So, you have to have a physician actually request that from the pharmacy, and there aren't too many pharmacies that are actually licensed to produce 82M. But 82M was minoxidil. flucinolone and tretinoin. And it was in a very, very, it is still in a very absorbable base. So it dries very quickly. It doesn't create irritation in the vast majority of patients, and it's much easier to use than the over the counter Rogaine.
Dr. Alan Bauman: So that was like the OG compounded Rogaine treatment. Alternative. And then years ago we added finasteride to that. So now instead of 82 M, that's called 82 F 82 F minoxidil, finasteride, flucinolone and tretinoin again in that really special base that absorbs very nicely. And that's a very, very common and very popular treatment option in the practice.
Dr. Alan Bauman: You've got to apply that twice a day. And we also now have topical dutasteride. So dutasteride plus minoxidil plus everything else we just mentioned.
Dr. Justin Marchegiani: Very good. And then, and then you mentioned the tretinoin. That's there to activate that minoxidil That's the active constituent, correct?
Dr. Alan Bauman: So, so tretinoin does a few different things.
Dr. Alan Bauman: There's been some studies that show that tretinoin by itself, retin A, can actually stimulate some hair regrowth. Some people in the clinical literature have proposed the idea that the tretinoin makes the minoxidil penetrate better through the skin. And what we know now is that the sulfotransferase enzyme, which is a critical component.
Dr. Alan Bauman: Converting step from minoxidil, which comes out of the bottle when it goes into the skin, that enzyme sulfotransferase converts it into the active, you mentioned previously, minoxidil sulfate. And so tretinoin increases that activity of the sulfotransferase, which is that enzyme. So you get a much more powerful minoxidil effect.
Dr. Justin Marchegiani: Very good. And then the exosomes. Talk about the exosomes. This is kind of newer therapy. I had a patient that was down at a, I think a conference you were doing and you were actually doing some exosome injections there. Can you talk more about that?
Dr. Alan Bauman: So exosomes is really the rising star of stem cell therapy.
Dr. Alan Bauman: And just to be clear with people, obviously they're, you know, the FDA has changed its opinion a little bit on exosomes. And so we no longer inject exosomes into patients, but we can use exosomes topically. And so it's okay to do that. Exosomes just so we're all clear and talking about the same thing.
Dr. Alan Bauman: And exosome is literally just a package, right? It's, it's like a little bubble that comes off of a cell and that package contains some very important ingredients, but it depends on what cells it's coming from and also what environment that cell is undergoing. So the exosome package is a transport, let's say.
Dr. Alan Bauman: bubble that contains micro R. N. A. Cytokines, other growth factors and things that are geared to tell the surrounding tissue what to do. So, for example, if you have an injured knee and you get stem quote unquote stem cell therapy with mesenchymal stem cells placed into that injury, what those cells do is they sense the location, they understand what's happening and then they send out messages to that local area.
Dr. Alan Bauman: Years ago, we used to think that stem cell therapy would actually, those cells would become the knee. Well, they don't. They just tell the other parts of the knee what to do. Right? Increase blood flow, repair this, reduce inflammation, increase inflammation, whatever. And so the way that stem cells regulate that is through the release of exosomes.
Dr. Alan Bauman: So, if you have in a laboratory, let's say a bioreactor with a whole boatload of stem cells in there, and you put them under a low oxygen environment, and then you collect those messages that come out from those cells. You quantify them, purify them, sterilize them, concentrate them and freeze them. Then you have yourself an exosome treatment in a little bottle.
Dr. Alan Bauman: It might contain billions or even a trillion or more exosomes within a small vial. And then those exosomes can be used for tissue regeneration and repair. Like I said, for skin rejuvenation or for wound healing. You know, those are all possible therapeutic applications of exosomes. So there are a variety of different exosomes that are out there, lots of different tissue banks that are making exosomes.
Dr. Alan Bauman: Exosomes are found also in placental tissue, they're found in your saliva, they're found in your tears, they're found in semen and urine, you name it, exosomes are everywhere. So you want to make sure what is the cell, what is the master cell line that's producing the exosomes? How are those cells treated when they're in the laboratory to release the exosomes?
Dr. Alan Bauman: And then how are those exosomes then processed? Because that makes a difference also. In the literature, we've seen that different processing tools and techniques result in different biologic activity in the laboratory. So there's a lot of nuance there. Yes, we do use exosomes. It is a, a very, very powerful regenerative medicine.
Dr. Alan Bauman: therapy. And we're gonna learn, we're learning more and more every single year, every single week and every month here that goes forward. Exosomes are very, very exciting.
Dr. Justin Marchegiani: Dr. Justin Marchegiani Very cool. Now, someone wants to kind of get a consult with you to say, Hey, you know, should I go a pharmaceutical route?
Dr. Justin Marchegiani: Or is there a more natural route? Or hey, when should I look at, you know, getting a hair transplant. What's the best way for these people to reach out to you?
Dr. Alan Bauman: So the very, very best way to connect with me from your home or phone from anywhere in the world is through the website, baumanmedical. com. B A U M A N medical.
Dr. Alan Bauman: com. And you can start a virtual consultation as nearly 50 percent of our patients do by just clicking on, you know, schedule consult. If you want to just ask a question, you can go to baumanmedical. com and just ask any type of question, whether it's crazy or not. And I'll get an answer out to you. But of course there's a lot of things we can do through virtual, you know, phone consultation, getting your information, whether it be blood work and photos and things like that.
Dr. Alan Bauman: But there's also things that we can't do. So if you can come down to South Florida to our 12, 000, nearly 12, 000 square foot facility here in downtown Boca Raton you know, we can really evaluate your hair with these AI powered microscopes, measure you with a hair check trichometer. Get to the bottom of your scalp inflammation or any other symptoms that you might have and really dig into really from a functional medicine approach.
Dr. Alan Bauman: My functional medicine department, what's going on that could be dysregulating your hair in addition to male or female pattern hair loss or 100 other diagnoses that you could potentially have that are affecting hair growth. Dr. Justin Marchegiani
Dr. Justin Marchegiani: Very cool. What's the price range for an FUE hair transplant today?
Dr. Justin Marchegiani: Maybe at the low end, a thousand follicles up to, you know, your high end. What's that broad range?
Dr. Alan Bauman: Yeah, well, hair transplants range, obviously, because of the size of the session and the method and the manner that we do the work. No shave is different than a full shave. Procedures can range anywhere from 10 to 50, 000.
Dr. Alan Bauman: You know, it's not a Transcribed by https: otter. ai you know, fee schedules out there, but we also provide service and results and care like no other clinic in the world.
Dr. Justin Marchegiani: That's great, Dr. Allen. Really appreciate it. Anything else you want to leave the listeners with?
Dr. Alan Bauman: Just that if you're out there and you're suffering with some hair loss, maybe you think that you might be, you're not sure whether you're a man or a woman you're seeing a receding hairline or more shedding in the shower or just more scalp shining through.
Dr. Alan Bauman: Your hair just looks and feels different. There's a lot we can do. Just reach out. We're here to help you. It all starts at baumanmedical. com and we'll escort you on your journey. We'll help you keep the hair that you have and restore the hair that you've lost. It'd be our pleasure to help
Dr. Justin Marchegiani: you. Thanks so much, Dr.
Dr. Justin Marchegiani: Allen. Excellent. Thank you.
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